Request Records

Patients and legal guardians complete the Request to Access PHI Form and return by mail, fax or the email address provided below.

pdfRequest to Access PHI Form

Return completed form by mail to:
Health Information Management Department
400 N. Caldwell
Staunton, IL 62088
Fax: 618-288-0024
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

If you need assistance with your request for medical records, please call the Health Information Management Department at 618-635-4257.